Digestive Diseases - Gastroenterology

Diagnosis and Treatment

At Mount Sinai, we are dedicated to your care by creating the most effective treatment plan personalized for you. We use only the latest endoscopic tools for safe and minimally invasive diagnosis and treatment of your pancreatic and biliary disorders.

What makes our pancreatic and biliary disease program unique is the high degree of expertise our doctors have in the diagnosis of these disorders. We use advanced imaging techniques that allow for the early detection of malignancies and diseases of the pancreas and bile ducts.

Endoscopic Retrograde Choliangiopancreatography (ERCP)

ERCP is an endoscopic procedure that allows us to visualize and examine the pancreatic duct and bile ducts.

Your doctor inserts a thin tube with a camera on its tip into your mouth to reach the small intestine at the opening of the bile duct and pancreas duct. A tiny catheter is used to enter the opening of the duct to injection contrasting material into the ducts where X-rays show the pancreas and bile ducts. This procedure helps us identify any abnormalities, such as stones, strictures, leaks, and tumors.  

ERCP also allows treatment of a variety of disorders, allowing us to remove stones, do biopsies of growths and tumors, place stents to widen strictures and close leaks, and treat tumors.

Endoscopic Ultrasound (EUS)

EUS is an endoscopic procedure that allows your doctor to get highly detailed views of your bile ducts, gallbladder, liver, and pancreas.

To perform the EUS, we insert a thin tube with a camera and ultrasound probe on its tip into your mouth. We gently move the probe into the stomach and small intestine where we can see organs near the stomach and small intestine. EUS allows for the most detailed evaluation of the bile ducts, gallbladder, liver, and pancreas. It can identify small abnormalities that CT scans or MRCP cannot see.

EUS also has the advantage of allowing for the insertion of a thin needle directly, for a fine needle aspiration (FNA), a type of biopsy. EUS-guided FNA is the gold standard test for evaluation of pancreatic mass lesions, cysts, and unexplained pancreatitis. 

Therapeutic Endoscopic Ultrasound

Since EUS-guided FNA is so safe and effective, we have been able to adapt this technique to treat pancreas and bile duct conditions.

Some ways we use EUS-guided FNA include:

  • Celiac plexus blockade and neurolysis: treats pain related to chronic pancreatitis and pancreatic cancer
  • Fiducial placement into tumors: delivers external beam radiation therapy with great precision
  • Access to the bile duct and pancreas duct: allows us to reach areas otherwise blocked by tumors or other structures in the GI tract
  • Pancreatic fluid collections and walled off necrosis: enables drainage of affected areas
  • Ablation of tumors in the pancreas, liver, and lymph nodes: facilitates injection of alcohol and radiofrequency ablation

Cholangioscopy and Pancreatoscopy

Mount Sinai was among the first programs in the nation to use single-operator digital cholangioscopy and pancreatoscopy to evaluate pancreatic and bile duct disorders.

These techniques use miniature video cameras that are small enough to insert through the ERCP scope directly into the bile ducts and pancreas ducts. This gives your doctor the ability to directly visualize and assess strictures and growths. We can detect cancers and use biopsy forceps to remove bile duct and pancreas duct stones.

Optical Endomicroscopy

We are able to use a whole new generation of advanced imaging techniques to diagnose and therefore better treat you. Optical endomicroscopy probes enable real-time microscopic assessment of the affected organ. They also provide further information, allowing us to detect pre-cancerous and cancerous lesions of the bile duct and pancreas. We currently use two types of optical endomicroscopy systems: confocal laser endomicroscopy, and optical coherence tomography.

At Mount Sinai, our doctors can diagnose and treat your pancreatic and bile duct disorders with the latest technologies and most effective techniques.